Organization
FRONT LINE EMERGENCY CARE SPEC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL C STEPHEN M.D. (DELEGATED OFFICIAL)
(562) 809-3571
Entity
Organization
Contact information
Practice address
3630 E IMPERIAL HWY, LYNWOOD, CA 90262-2609
(310) 900-8900
Mailing address
PO BOX 12110, WESTMINSTER, CA 92685-2110
(562) 809-3571
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0019210
—
CA
Enumeration date
08/05/2006
Last updated
04/24/2008
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